A plan by Highmark Inc. to streamline its pharmacy network and a contract dispute between Walgreen Co. and Express Scripts, which manages UPMC Health Plan’s pharmacy program, could have many Walgreens customers looking for a new pharmacy soon.

Beginning in January, Highmark will begin its transition to a new network that will exclude Walgreens and Target pharmacies.

The move, initially affecting about 100,000 members of Highmark’s small group market, will be completed by Dec. 31, 2013, according to a statement from the insurer.

The move was a result of Highmark’s ability “to negotiate more aggressive discounts with the pharmacies that remained in the network, resulting in savings for Highmark’s employer groups and members,” the statement said.

While the Highmark pharmacy network will go from 61,000 pharmacies to 52,000, Highmark officials say more than 96 percent of its members will still be within seven miles of a network pharmacy.

Find out more at the Post-Gazette.

Major health insurance companies have been charging sharply higher premiums this year, outstripping any growth in workers’ wages and creating more uncertainty for the Obama administration and employers who are struggling to drive down an unrelenting rise in medical costs.

A study released on Tuesday by the Kaiser Family Foundation, a research group, showed that the average annual premium for family coverage through an employer reached $15,073 in 2011 — 9 percent higher than in the previous year. And even higher premiums could be on the way, particularly in New York, where some companies are asking for double-digit increases for about 1.3 million New Yorkers in individual or small-group plans, setting up a battle with state regulators.

The higher premiums are particularly unwelcome at a time when the economy is sputtering and unemployment is hovering at about 9 percent. Many businesses cite the cost of coverage as a factor in their decision not to hire, and health insurance has become increasingly unaffordable for more Americans. The cost of family coverage has about doubled since 2001, compared with a 34 percent gain in wages.

Read more the NYT’s in-depth story on this issue.

Highmark Blue Cross Blue Shield is partnering with 14 health-related sites in Allegheny County to offer members and nonmembers alike programs to help them lose weight, eat better and manage stress or chronic conditions like diabetes and osteoporosis.

“These programs are lifestyle improvement programs,” said Atiya Abdelmalik, Highmark manager of health promotion. “They’re not the latest craze. They’re not a quick fix. They’re not the latest fad diet. We’re equipping members with the resources they need to live a healthier life.”

With one exception, the Wellness Where You Live programs are free to members; cost to non-members depends on length of the programs, but all start at $65, she said.

Highmark has designed a total of eight wellness programs; not all of them are offered at each participating site.

Read the full article: 14 sites to offer wellness programs

A medical home seems like the most logical thing in the world.

It’s a place where a family doctor and staff look after all aspects of their patients’ health.

Yet it’s not the norm. Doctors generally get paid for treating patients when they are sick but not for keeping them healthy, or for making sure they’re following treatment.

Now PinnacleHealth and Capital BlueCross are collaborating to give people medical homes.

It will begin as a pilot program at Pinnacle-owned family practices in Lower Paxton Twp. and Marysville. The two practices serve about 20,000 patients, said Joey Sevison, PinnacleHealth’s vice president of family practice management.

If successful, the concept could be expanded to patients at all 12 PinnacleHealth-owned family practices.

The recently approved health care reform plan includes financial incentives aimed at promoting the medical home concept, long touted by the medical profession as a key to improving health.

Read more.

In a bid to boost beleaguered primary-care doctors and encourage more preventive care for the public, Independence Blue Cross announced a plan Thursday to pay physicians more if their patients’ health improves.

Independence, the region’s largest health insurer, will spend an extra $47 million a year to increase base pay and double incentive programs that already encourage primary-care doctors to deliver higher quality and less costly care.

Starting July 1, a doctor with 850 Keystone HMO patients could earn up to $150,000 more a year, said Steven Udvarhelyi, executive vice president of health services at Independence.

“We think this is a significant opportunity for primary care physicians who are doing a good job,” he said. “It is a great incentive for them to improve over time.”

Eric Grossman, a senior partner at the consulting firm Mercer, in Norwalk, Conn., said that while insurers have dabbled with so-called pay-for-performance models, Independence’s effort was a significant development.

The insurer “has definitely, by this announcement, inserted themselves into the early adopters of that movement,” Grossman said.

Find out more.

Several major for-profit U.S. health insurers have announced they’ll let most adult children continue health coverage under parents’ insurance policies earlier than required under recently adopted federal health care reforms.

UnitedHealthcare, WellPoint Inc. and Humana are among the first U.S. insurers to announce plans to extend coverage to unmarried adult children before the Sept. 23 effective date.

But it’s unclear if the Philadelphia region’s largest insurers will follow.

Independence Blue Cross is assessing all aspects of the health reform bill including dependents to age 26 and at this time has not finalized implementation plans, spokeswoman Ruth Stoolman said.

“The regulations regarding this new aspect of the law have not been written and we’re waiting to see what that will include,” Stoolman added.

But employers with Blue Cross coverage now can opt to add dependents to age 30, Stoolman said.

The coverage can be added to age 19, 23, 25 and 30, but it’s up to an employer to decide to offer it, Stoolman said. Not many employers opted to extend coverage to age 30, she added.

Aetna, the region’s second largest insurer, has “nothing to announce at this time,” spokesman Walt Cherniak said.

Pennsylvania Insurance Department spokeswoman Roseanne Placey said other carriers have not notified the department of intentions to implement the coverage extension early. She added as more reform mandates go into effect, the agency will be doing market surveillance activities.

Read more.

And for the Northeastern PA area, the Times-Tribune reports:

Two major health insurance companies announced Wednesday they would fast-track a federal program to allow young adults to remain on their parents’ policies until age 26.

Blue Cross of Northeastern Pennsylvania will allow young adults up to age 26 to remain covered on a parent’s existing policy starting June 1. Aetna announced a similar decision Wednesday.

The companies followed in the footsteps of United Health Care, Humana, Kaiser Permanente and WellPoint Inc. in expanding the age at which children can be covered under health care reform passed by Congress in March.

The new law will allow young adults to stay on or return to a parent’s insurance plan until age 26. Most public and private health plans do not cover dependents after age 19, though many private plans will cover full-time college students on their parents plans until age 23.

The federal law under health care reform does not take effect until Sept. 23, which would create a coverage gap for people graduating from college this spring or summer.

“We were getting a lot of questions from members about bridging the coverage gap,” Blue Cross spokesman Anthony Matrisciano said. “We wanted to ensure that these young adults could keep their coverage.”

Traditionally, adults 19 to 29 are the most likely to be uninsured, according to Mark Pauly, Ph.D., a health care economist at the University of Pennsylvania. About 15 percent of people ages 19-44 are uninsured across the state, according to a survey done in 2008 by the state Insurance Department. No data was available on the 19-26 age group.

Pittsburgh-based Highmark Inc. this year plans to open four more Highmark Direct health insurance retail stores, one in the midstate.

The insurer, which has a strong presence in Central Pennsylvania, opened the state’s first such stores in March 2009, one of which was in Cumberland County.

The new store in Central Pennsylvania will be in the Colonial Commons Shopping Center, 5116 Jonestown Road, Lower Paxton Township; the remaining three will be in Western Pennsylvania.

“When we opened our first two stores last year, our goal was to provide Pennsylvanians with access to the information they need to make informed decisions about health insurance,” said Dr. Kenneth R. Melani, president and CEO, in a statement. “The stores have exceeded our expectations during the first year of operation. By opening four new facilities, our Highmark Direct stores will reach many more people in our community.”

Health insurer Highmark Inc. doubled its profits in 2009, according to financial results announced this morning. Highmark said it had net income of $187.7 million, up from $94.1 million in 2008.

Net profit amounted to 1.4 percent of total income, up from 0.7 percent the previous year. Highmark reported total revenue of $13.7 billion, up from $13 billion. Highmark said 90 percent of health insurance premiums went toward medical care for members.

Highmark, which is based in Pittsburgh and has extensive operations in Cumberland County, attributed the profit growth to improved investment returns and strong performance and growth among its subsidiaries, which include companies that provide vision and dental benefits.

Highmark also said that, despite the poor economy and widespread job losses, the number of people with health insurance through Highmark has remained fairly steady. The company said it had ended 2009 with 4.7 million health insurance members, down from 4.8 million at the end of 2007.

Find out more.